OBJECTIVE: To evaluate whether postpartum pelvic floor muscle training decrease prevalence of any urinary incontinence (UI) in primiparous women with and without UI at inclusion (mixed population) and further to perform stratified analyses on women with and without major levator ani muscle defects.
METHODS: A two-armed assessor-blinded randomized controlled trial including primiparous women 6 weeks after vaginal delivery was conducted. Participants were stratified on major levator ani muscle defects, verified by transperineal ultrasonography, and thereafter randomly allocated to training or control. All participants were taught to contract the pelvic floor muscles. The control participants received no further intervention, whereas training participants attended a weekly supervised pelvic floor muscle training class and performed daily home exercise for 16 weeks. Primary outcome was self-reported UI analyzed by relative risk.
RESULTS: We included 175 women, 55 with major levator ani muscle defects and 120 without. Prevalence of UI at baseline was 39.1% in the training group (n=87) and 50% among those in the control group (n=88). Fifteen women (8.6%) were lost to follow-up. At 6 months after delivery (postintervention), 34.5% and 38.6% reported UI in the training and control groups, respectively. Relative risk analysis of UI gave a nonsignificant effect size of 0.89 (95% confidence interval [CI] 0.60–1.32). Results were similar for the stratum with and without major levator ani muscle defects, 0.89 (95% CI 0.51–1.56) and 0.90 (95% CI 0.53–1.52), respectively.
CONCLUSIONS: Postpartum pelvic floor training did not decrease UI prevalence 6 months after delivery in primiparous women. Stratified analysis on women with and without major levator ani muscle defects showed similar nonsignificant results.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01069484.
LEVEL OF EVIDENCE: I
Postpartum pelvic floor training did not decrease urinary incontinence prevalence 6 months after delivery in primiparous women with or without major levator ani muscle defects.
Department of Sports Medicine, Norwegian School of Sport Sciences, and the Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Corresponding author: Gunvor Hilde, Norwegian School of Sport Sciences, Department of Sports Medicine, PO Box 4014, Ullevål Stadion, 0806 Oslo, Norway; e-mail: firstname.lastname@example.org.
Supported by grants from The Research Council of Norway.
The authors thank midwife Tone Breines Simonsen for recruiting participants and administering clinical appointments and electronic questionnaires; physical therapist Kristin Gjestland for clinical testing and data entering; physical therapists Ingeborg Hoff Brækken, Vigdis Skøld, and Ingvild Sandholt for supervising the interventional group training sessions; and Professor Ingar Holme, PhD, for statistical advice.
Financial Disclosure The authors did not report any potential conflicts of interest.